Healthcare Provider Details

I. General information

NPI: 1700966991
Provider Name (Legal Business Name): GREGGORY A KINZER DDS MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BROADWAY STE 490
SEATTLE WA
98122-5312
US

IV. Provider business mailing address

600 BROADWAY STE 490
SEATTLE WA
98122-5312
US

V. Phone/Fax

Practice location:
  • Phone: 206-223-0033
  • Fax: 206-860-2868
Mailing address:
  • Phone: 206-223-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDE00008164
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: